The Accuracy of Incident Vertebral Fracture Detection in Children Using Targeted Case ‐Finding Approaches

In this study, we examined the accuracy of case ‐finding strategies for detecting incident vertebral fractures (IVF) over 2 years in glucocorticoid‐treated children (n = 343) with leukemia, rheumatic disorders, or nephrotic syndrome. Two clinical situations were addressed: the prevalent vertebral fracture (PVF) scenario (when baseline PVF status was known), which assessed the utility of PVF and low lumbar spine bone mineral density (LS BMD;Z‐score< −1.4), and the non‐PVF scenario (when PVF status was unknown), which evaluated low LS BMD and back pain. LS BMD was measured by dual‐energy X‐ray absorptiometry, vertebral fractures were quantified on spine radiographs using the modified Genant semiquantitative method, and back pain was asse ssed by patient report. Forty‐four patients (12.8%) had IVF. In the PVF scenario, both low LS BMD and PVF were significant predictors of IVF. Using PVF to determine which patients should have radiographs, 11% would undergo radiography (95% confidence interval [CI] 8–15) with 46% of IVF (95% CI 3 0–61) detected. Sensitivity would be higher with a strategy of PVFor low LS BMD at baseline (73%; 95% CI 57 –85) but would require radiographs in 37% of children (95% CI 32–42). In the non‐PVF scenario, the strategy of low LS BMDand back pain produced the highest specificity of any non ‐PVF model at 87% (95% CI 83–91), the greatest overall accuracy at 82% (95% CI 78–86), and the lowest radiography rate at 17% (95% CI...
Source: Journal of Bone and Mineral Research - Category: Orthopaedics Authors: Tags: Original Article Source Type: research